The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism

Objective To determine threshold cytomegalovirus (CMV) infectious rates and treatment effectiveness to make universal prenatal CMV screening cost-effective. Study Design Decision analysis comparing cost-effectiveness of two strategies for the prevention and treatment of congenital CMV: universal prenatal serum screening and routine, risk-based screening. The base case assumptions were a probability of primary CMV of 1% in seronegative women, hyperimmune globulin (HIG) effectiveness of 0%, and behavioral intervention effectiveness of 85%. Screen-positive women received monthly HIG and screen-negative women received behavioral counseling to decrease CMV seroconversion. The primary outcome was the cost per maternal quality-adjusted life year (QALY) gained with a willingness to pay of $100,000 per QALY. Results In the base case, universal screening is cost-effective, costing $84,773 per maternal QALY gained. In sensitivity analyses, universal screening is cost-effective only at a primary CMV incidence of more than 0.89% and behavioral intervention effectiveness of more than 75%. If HIG is 30% effective, primary CMV incidence can be 0.82% for universal screening to be cost-effective. Conclusion The cost-effectiveness of universal maternal screening for CMV is highly dependent on the incidence of primary CMV in pregnancy. If efficacious, HIG and behavioral counseling allow universal screening to be cost-effective at lower primary CMV rates.

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The cost-effectiveness of human immunodeficiency virus screening in pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(96)70455-6 ◽

1996 ◽

Vol 174 (2) ◽

pp. 716-721 ◽

Cited By ~ 17

Author(s):

Jeffrey L. Ecker

Keyword(s):

Human Immunodeficiency Virus ◽

Cost Effectiveness ◽

Immunodeficiency Virus ◽

Human Immunodeficiency Virus Screening ◽

The Cost ◽

In Pregnancy ◽

Virus Screening

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Do we need to screen and treat pregnant women for subclinical hypothyroidism? A cross sectional study in a rural tertiary centre in Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170470 ◽

2017 ◽

Vol 6 (3) ◽

pp. 781

Author(s):

Radha K. R. ◽

Nishu Sugunan ◽

Resmy C. R.

Keyword(s):

Pregnant Women ◽

Subclinical Hypothyroidism ◽

Universal Screening ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Maternal Complications ◽

Cross Sectional ◽

Neonatal Hypothyroidism ◽

In Pregnancy

Background: Hypothyroidism (HT) is associated with maternal and perinatal morbidity. Subclinical HT rather than overt occur in pregnancy, because overt HT causes infertility. Treatment of overt HT was beneficial in reducing the fetal and maternal complications, Usefulness of correcting subclinical hypothyroidism was doubtful, hence Universal screening of pregnant women was not recommended.Methods: Cross sectional study, conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur, Kerala, India. 50 consecutive cases of subclinical hypothyroidism in pregnancy were analyzed for Thyroid function, antenatal, natal, postnatal complications. Perinatal complications, including neonatal hypothyroidism also noted. Statistical analysis done using computer software Epi info3.4. Data expressed in its frequency and percentage, continuous data in mean.Results: All women in the study group received levothyroxine during pregnancy from time of diagnosis. At the time of delivery 84% women were euthyroid and 16% hypothyroid. Complications like anemia 36%, abruption 4%, and postpartum hemorrhage 6% showed a statistically significant association, while pre-eclampsia 20%, preterm labor 22% had no statistically significant association. Comparing the women who are euthyroid as a result of levothyroxine supplementation to women inadequately treated, complications like anemia (33% versus 50%, p value 0.042), abruption (0% versus 4%, p value0.023), PPH (2% versus 6%, p value 0.014) were significantly less in well controlled.Conclusions: Significant association was noted between inadequately treated hypothyroidism and maternal complications like anaemia, placental abruption, placenta previa, PPH, preterm delivery, and caesarean section rate for foetal distress. Universal screening of pregnant women for thyroid status is recommended.

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Group B streptococcus infection in pregnancy: an update

Fetal and Maternal Medicine Review ◽

10.1017/s0965539599000145 ◽

1999 ◽

Vol 11 (1) ◽

pp. 31-39 ◽

Cited By ~ 1

Author(s):

Geralyn C O'Reilly ◽

Jane E Hitti ◽

Thomas J Benedetti

Keyword(s):

Cost Effectiveness ◽

Streptococcus Agalactiae ◽

Neonatal Sepsis ◽

Early Onset ◽

Group B Streptococcus ◽

Group B ◽

The Cost ◽

In Pregnancy

Group B streptococcus (GBS), or Streptococcus agalactiae, has been a continuing focus of debate in the paediatric and obstetric worlds. The organism has emerged as the leading cause of early-onset neonatal sepsis. With an average of 20% of mothers being carriers for the organism (range from 15–40%), the following questions remain to be answered:1 How best to screen for GBS and which protocol to use?2 How best to counsel patients who are GBS carriers?3 What is the cost effectiveness of the screening protocols?

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Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽

10.1136/bmjopen-2020-038505 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038505

Author(s):

Susie Huntington ◽

Georgie Weston ◽

Farah Seedat ◽

John Marshall ◽

Heather Bailey ◽

...

Keyword(s):

Cost Effectiveness ◽

Pregnant Women ◽

Neonatal Death ◽

Cost Effective ◽

Screening Strategy ◽

Base Case ◽

Scenario Analyses ◽

The Uk ◽

The Cost ◽

In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

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